First Known Case of 'Fixed Food Eruption' Triggered by Grapes, Wine.htm

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FromSkin & Allergy News First Known Case of 'Fixed Food Eruption' Triggered by Grapes, Wine L. Goldman

[skin & Allergy News 30(10):37, 1999. © 1999 International Medical News Group.]

NEW YORK -- Talk about "grapes of wrath."

Red wine, fresh grapes, and raisins appeared to be the culprits in what dermatologists at Wayne State University, Detroit, diagnosed as a "fixed food eruption" in one of their patients.

The case described by Dr. ne Gee in a poster presentation at the American Academy of Dermatology's Academy '99 is one of only a handful of such reports in the dermatologic literature.

A variant of the more familiar fixed drug eruption, this phenomenon involves repeated emergence of well-circumscribed erythematous and edematous plaques, accompanied by burning or itching sensations, at the same anatomic sites immediately following each ingestion of a specific food substance.

In past reports, the offending agents have included lentils, strawberries, and cheese crisps. This is the first report of a fixed food eruption in association with grapes.

The patient is a 60-year-old white man with a long history of drug allergy to penicillin, which caused urticaria, lactose intolerance, and adverse responses (diarrhea) to orange juice.

Approximately 2 years prior to presentation, he noticed the sudden emergence of "dark spots" on his legs immediately after eating a large number of red grapes. These lesions resolved in about 1 month. Six months later, he noticed a dark spot on his glans penis, as well as on his arms and on the same areas of his legs as in the previous episode; this occurred after he had eaten green grapes. These lesions also resolved in 1 month. Roughly 1 year ago, he reported drinking approximately 8 ounces of red wine and "broke out in dark spots all over." The patient continued to have red wine at his church communion service once a week, and the lesions persisted throughout this period.

His medical history was largely unremarkable. Other than the thyroid hormone, he reported no other medication or supplement use beyond occasional vitamins. Physical examination revealed several scattered, sharply demarcated, monochromatic, hyperpigmented patches on bilateral arms and legs, the chest, and the back, Dr. Gee reported. The lesions varied in size from 1 to 3 cm in diameter. At the time of examination, there were no signs of hyperpigmentation on the glans penis or oral mucosa.

The histology showed pigment incontinence, characterized by the presence of melanin in upper dermal macrophages. This, Dr. Gee explained, is a reflection of hydropic degeneration of the basal layer. Scattered dyskeratinocytes with eosinophilic cytoplasm and pyknotic nuclei were seen sporadically in the epidermis. These findings were consistent with the patterns seen in fixed eruptions.

Dr. Gee instructed the patient to cease all consumption of wine, grapes, and raisins. Over the course of the ensuing year, the lesions gradually faded.

The patient was rechallenged 1 year later with 8 ounces of white wine and somewhat surprisingly, did not have any reaction.

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